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Kirschenbaum D, Imbach LL, Jane Rushing E, Frauenknecht KBM, Gascho R T D, Victor Ineichen B, Keller E, Kohler S, Lichtblau M, Reimann RR, Schreib K, Ulrich S, Steiger P, Aguzzi A, Frontzek K
Neuropathol Appl Neurobiol - (-) - [2020-11-29; online 2020-11-29]
Coronavirus disease 19 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), has become a worldwide pandemic (1). Symptoms of COVID-19 vary widely and range from asymptomatic disease to severe pneumonia and multiorgan failure (2). A severe disease course is more likely in older patients and patients with pre-existing respiratory and cardiovascular conditions (2). Patients with severe Sars-CoV-2 infection may present with ischaemic stroke (3, 4) or even fatal intracerebral haemorrhage (5). To date, little is known about the neuropathological sequelae of COVID-19. The largest published autopsy series of COVID-19 neuropathology reported microthrombi and acute haemorrhagic infarction in a significant number of patients (6), while another more recent study found evidence of lymphocytic encephalitis and meningitis (7). Endotheliitis of the brain and extraneural organs has been shown in Sars-CoV infected patients (8). Similarly, it is a recurrent feature in the lungs and other peripheral organs of Sars-CoV-2 infected patients (9) but has not yet been reported in the central nervous system. We speculated that cerebrovascular pathology in COVID-19 patients could be a direct consequence of hitherto unidentified cerebral endotheliitis caused by Sars-CoV-2.
PubMed 33249605
DOI 10.1111/nan.12677
Crossref 10.1111/nan.12677
NA: Provided in the article: Clinical and pathological characteristics of four patients